In the area of wound care, which is understood to include burns, pressure sores, ulcers and the like, it is typical to focus the choice/design of dressings or medicaments on the specific requirements of the wound itself. The most complete and effective wound care, however, concerns itself additionally with the needs of:
(1) the epithelium, which is the tender area of new cell growth directly peripheral to the wound; and,
(2) the surrounding non-wounded skin. Indeed, many dermatologists feel that care of the epithelium and surrounding skin is paramount in the successful treatment of wounds, such as leg ulcers. Since the epithelium is the area in which the actual healing occurs (i.e., it is generally accepted that healing of a wound occurs by cell growth from the periphery inward), great care should be taken not to damage this area. Problems occur during dressing changes when either the dressing adheres to this area or when the new cell growth becomes entwined within the matrix of the dressing. Injury to the epithelium during dressing changes can effectively negate the care provided to the wound.
The non-wounded skin beyond the epithelium is usually in contact with some portion of the wound dressing system which maintains the dressing positioned on the wound. For example, the surrounding skin may be covered for extended periods with a wrap and/or adhesive to hold the dressing in place. Many such dressings can irritate this surrounding skin and compound the problem to the patient. This is especially true in the area of leg ulcers wherein the surrounding skin can easily become sensitized by strong medicaments and is often plagued with flaking, scaling and eczema.
The time frame for the changing of dressings depends on the above concerns and therefore opinions as to how often dressings should be changed vary drastically. It may be highly desirable to change dressings often in certain cases where the wound is emitting a large volume of exudate. Also, considering the various types of dressings available and the various stages in the healing process, dressings should ideally be altered to optimally treat the then-present condition of the wound.
In the area of leg ulcers one type of treatment presently used comprises the application of gauze to the ulcer and the utilization of a compression wrap to secure the gauze to the ulcer. Since the gauze quickly becomes saturated, frequent changes are necessary and damage to the epithelium and surrounding skin may occur. If the gauze is left on for too long a period, the exudate which contains proteolytic enzymes can begin to digest the patient's surrounding skin.
A second type of treatment is the Unna's Boot (commercially available from Biersdorf, Inc.) which comprises a zinc paste-containing bandage wrapped around the patient's leg from above the toes to below the knee. Other Unna's Boot/zinc impregnated treatments are available from Miles and Graham Field. This dressing is typically left in place for a week at a time and absorbent pads must be applied to the outside of the dressing in the area of the ulcer to absorb excess exudate. Seepage of exudate throughout the wrap is common, however, and damage to the skin and epithelium is inevitable.
A wound dressing system which could facilitate frequent dressing changes, while protecting the epithelium and surrounding non-wounded skin, would be a useful addition to the wound care art.